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16-01-2024 | Chronic Kidney Disease | Original Article

General practitioners’ representation of early-stage CKD is a barrier to adequate management and patient empowerment: a phenomenological study

Authors: Agnès Oude Engberink, Guillaume Tessier, Ilham Kamil, Gérard Bourrel, Olivier Moranne

Published in: Journal of Nephrology | Issue 2/2024

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Abstract

Background

In high-income countries, chronic kidney disease (CKD) affects over 10% of the population. Identifying these patients early is a priority, especially as new treatments are available to reduce the risk of cardiovascular and renal morbidity. We aimed at understanding the management and care pathway of patients with early-to-moderate CKD defined as an estimated glomerular filtration rate (eGFR) ≥ 45 mL/min/1.73 m2 (CKD-EPI), by analyzing the experience of general practitioners in a region in France.

Methods

This qualitative semiopragmatic phenomenological study analyzed in-depth interviews held with a purposive sample (age, gender, training, type of practice, rural/urban context) of 24 general practitioners, with triangulation of research until data saturation.

Results

From diagnostic, etiological and prognostic viewpoints, the general practitioners enrolled in our study perceived CKD as a complex, poorly-defined clinical entity in asymptomatic and multimorbid patients. They distinguished it from a rare condition they considered as ‘mainly renal’. The fact that they did not perceive early-stage CKD as a disease was a hindrance to patient care, which should protect the kidneys with a preventive approach. Indeed, general practitioners perceived CKD patient management as a pathway requiring a personalized, integrative model, common to all chronic diseases, without necessarily involving a nephrologist, at least in the early stages.

Conclusions

This study shows how the general practitioners’ representations influence their attitudes and interventions. Clarifying the concept of early-stage CKD by taking factors like age and etiology into account would facilitate personalized management of this heterogeneous, often multimorbid, population. Finally, organizational models to support patient empowerment in an integrative care pathway must be established and validated.

Graphical abstract

Appendix
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Metadata
Title
General practitioners’ representation of early-stage CKD is a barrier to adequate management and patient empowerment: a phenomenological study
Authors
Agnès Oude Engberink
Guillaume Tessier
Ilham Kamil
Gérard Bourrel
Olivier Moranne
Publication date
16-01-2024
Publisher
Springer International Publishing
Published in
Journal of Nephrology / Issue 2/2024
Print ISSN: 1121-8428
Electronic ISSN: 1724-6059
DOI
https://doi.org/10.1007/s40620-023-01838-y

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